Researchers in Pennsylvania have developed a tool comprising 4 preoperative clinical variables that surgeons and patients can use to predict the likelihood of type 2 diabetes remission after Roux-en-Y gastric bypass surgery.
Christopher D. Still, DO, director of Geisinger Obesity Institute, Danville, Pennsylvania, and colleagues developed their algorithm, known as the DiaRem score, on the basis of a retrospective cohort study of 690 patients who underwent gastric bypass surgery. They verified the results in 2 additional cohorts; their findings were published online September 13 in the Lancet Diabetes and Endocrinology.
DiaRem scores range from 0 to 22, with low scores consistently predicting higher remission rates and high scores predicting lower remission rates.
"Bariatric surgery is a very effective tool not so much for weight loss but curing or resolving comorbid medical problems," Dr. Still told Medscape Medical News in a telephone interview. "The surgery is the best we have for long-term success, but it's not without potential risks and costs."
âWhat we found was that the cardiac structure and function in these extremely obese adolescents scheduled for bariatric surgery was much more impaired than one might have thought,â said John Bauer, PhD with Nationwide Childrenâs Hospital.
The hearts and function of super-morbidly obese adolescents before undergoing bariatric surgery -- were that of middle-aged persons.
After bariatric surgery -- the teens' hearts underwent change -- reverting to a healthier state.
RNY patients lose more than gastric band patients, and this study hypothesizes that RNY patients "think" differently about food.
As a ten-year RNY patient - I scream - AYE! FOR THE LOVE OF DOG DO NOT FEED ME ICE CREAM!
It's called DUMPING SYNDROME, our brains learn to connect certain foods to the reactions they might or will cause, which is a learned behavior, and our brains react, which can be SEEN on an MRI machine. Twitch. Twitch. (And, no, many people never ever learn.)
Objectives Roux-en-Y gastric bypass (RYGB) has greater efficacy for weight loss in obese patients than gastric banding (BAND) surgery. We hypothesise that this may result from different effects on food hedonics via physiological changes secondary to distinct gut anatomy manipulations.
Design We used functional MRI, eating behaviour and hormonal phenotyping to compare body mass index (BMI)-matched unoperated controls and patients after RYGB and BAND surgery for obesity.
Results Obese patients after RYGB had lower brain-hedonic responses to food than patients after BAND surgery. RYGB patients had lower activation than BAND patients in brain reward systems, particularly to high-calorie foods, including the orbitofrontal cortex, amygdala, caudate nucleus, nucleus accumbens and hippocampus. This was associated with lower palatability and appeal of high-calorie foods and healthier eating behaviour, including less fat intake, in RYGB compared with BAND patients and/or BMI-matched unoperated controls. These differences were not explicable by differences in hunger or psychological traits between the surgical groups, but anorexigenic plasma gut hormones (GLP-1 and PYY), plasma bile acids and symptoms of dumping syndrome were increased in RYGB patients.
Conclusions The identification of these differences in food hedonic responses as a result of altered gut anatomy/physiology provides a novel explanation for the more favourable long-term weight loss seen after RYGB than after BAND surgery, highlighting the importance of the gutâbrain axis in the control of reward-based eating behaviour.
In a single-center study, patients who underwent the procedure lost an average 57.4% of excessive body mass index (BMI) over 5 years, Ralph Peterli, MD, of Claraspital in Basel in Switzerland, and colleagues reported online in the journalSurgery for Obesity and Related Diseases.
Laparoscopic sleeve gastrectomy, first developed about a decade ago, "was initially intended to be a primary intervention in high-risk patients before laparoscopicRoux-en-Y gastric bypass or as the first step of biliopancreatic diversion duodenal switch," the authors noted in their introduction. But evidence has been mounting that sleeve gastrectomy itself is an effective surgery for weight loss.
But there is still a dearth of long-term evidence for its benefit -- one reason Peterli and colleagues conducted a retrospective analysis of a cohort from their facility that had a minimum of 5 years' follow-up.
A total of 68 patients had laparoscopic sleeve gastrectomy at their center as either a primary bariatric procedure or as a re-operation after failed laparoscopic gastric banding between August 2004 and December 2007.
At the time of sleeve gastrectomy, mean BMI was 43 and 78% of patients were female. They had a mean follow-up of 5.9 years.
Overall, Peterli and colleagues found that the average excessive BMI lost after 1 year was 61.5%, and then 61.1% after 2 years.
By 5 years, average excessive BMI lost was 57.4%, they reported.
Those losses correspond with a BMI reduction of 12.6 kg/m2, 12.4 kg/m2, and 11.2 kg/m2, respectively.
"The main weight loss occurred in the first postoperative year and appeared in the following years for the most part stable," they wrote.
However, 34.3% of patients who had sleeve gastrectomy as their primary procedure and 50% of those who'd had it after a failed gastric banding still had a BMI above 35 kg/m2 after 5 years.
"Patients with a prior [gastric banding] show worse results concerning weight loss," they wrote, noting, however, that international consensus considers Roux-en-Y gastric bypass [RYGB] surgery as the best option following failed banding, not sleeve gastrectomy.
The study also showed that comorbidities improved considerably, with remission of type 2 diabetes in most of the patients who had the disease before the procedure.
Among four insulin-dependent patients, only one still needed insulin therapy 5 years after laparoscopic sleeve gastrectomy. Two were able to switch to oral antidiabetic therapy, while one remained in full remission at 5 years, they reported.
In terms of complications, one patient had a leak, two had incisional hernias -- which were deemed unrelated to treatment -- and 11 patients had new onset gastroesophageal reflux disease, which typically resolved with proton pump inhibitor therapy.
Over 5 years of follow-up, 77.9% of patients developed vitamin D deficiency, 41.2% had iron deficiency, 39.7% had zinc deficiency, 39.7% had a vitamin B12 deficiency, 25% had a folic acid deficiency, and 10.3% developed anemia.
These deficiencies occurred "despite routine supplementation, in a higher rate than we had expected," the researchers wrote.
They also found that re-operation due to insufficient weight loss was needed in eight patients, or 11.8% of the study population.
But they concluded that sleeve gastrectomy is effective nearly 6 years after the initial operation, with nearly 60% of excessive BMI still gone and a "considerable improvement or even remission" of comorbidities.
"Although sleeve gastrectomy was initially only carried out as the first part of a two-step procedure," they wrote, "we could show that a rather small percentage needed a second-line procedure ... for treatment of insufficient weight loss."
Laparoscopic Sleeve Gastrectomy (LSG) is gaining popularity, yet long-term results are still rare.
Objectives
We present the five-year outcome concerning weight loss, modification of co-morbidities and late complications.
Setting
University affiliated teaching hospital, Switzerland.
Methods
This is a retrospective analysis of a prospective cohort with a minimal follow-up of 5 years. A total of sixty-eight patients underwent LSG either as primary bariatric procedure (n=41) or as redo-operation after failed laparoscopic gastric banding (n=27) between August 2004 and December 2007. At the time of LSG the mean body mass index (BMI) was 43.0 ±8.0 kg/m2, the mean age 43.1 ±10.1 years, and 78% were female. The follow-up rate one year postoperatively was 100%, 97% after 2, and 91% after 5 years; the mean follow-up time was 5.9 ±0.8 years.
Results
The average excessive BMI loss after 1 year was 61.5 ±23.4%, 61.1 ±23.4% after 2, and 57.4 ±24.7% after 5 years. Co-morbidities improved considerably; a remission of type 2 diabetes could be reached in 85%. The following complications were observed: one leak (1.5%), 2 incisional hernias (2.9%), and new onset gastroesophageal reflux in 11 patients (16.2%). Reoperation due to insufficient weight loss was necessary in 8 patients (11.8%).
Conclusions
LSG was effective 5.9 years postoperatively with an excessive BMI loss of almost 60% and a considerable improvement or even remission of co-morbidities.
I don't know if I already shared THIS video, because I have watched it a few times, but I am having this test done next week June 6th with pre op on June 5th. This guy totally 'splains things in a understandable way. Snort.
It's not uncommon for those of us who have lost massive amounts of weight with bariatric surgery to have major issues with body dysmorphic disorder or problems seeing ourselves the way we really look.
Some post weight loss patients suffer terrible with body dysmorphia -- some to a much lesser degree.
But, could brains actually be different in those who have BDD?
Importance Weight loss surgery (WLS) has been shown to produce long-term weight loss but is not risk free or universally effective. The weight loss expectations and willingness to undergo perioperative risk among patients seeking WLS remain unknown.
Objectives To examine the expectations and motivations of WLS patients and the mortality risks they are willing to undertake and to explore the demographic characteristics, clinical factors, and patient perceptions associated with high weight loss expectations and willingness to assume high surgical risk.
Design We interviewed patients seeking WLS and conducted multivariable analyses to examine the characteristics associated with high weight loss expectations and the acceptance of mortality risks of 10% or higher.
Setting Two WLS centers in Boston.
Participants Six hundred fifty-four patients.
Main Outcome Measures Disappointment with a sustained weight loss of 20% and willingness to accept a mortality risk of 10% or higher with WLS.
Results On average, patients expected to lose as much as 38% of their weight after WLS and expressed disappointment if they did not lose at least 26%.
Most patients (84.8%) accepted some risk of dying to undergo WLS, but only 57.5% were willing to undergo a hypothetical treatment that produced a 20% weight loss.
The mean acceptable mortality risk to undergo WLS was 6.7%, but the median risk was only 0.1%; 19.5% of all patients were willing to accept a risk of at least 10%.
Women were more likely than men to be disappointed with a 20% weight loss but were less likely to accept high mortality risk.
After initial adjustment, white patients appeared more likely than African American patients to have high weight loss expectations and to be willing to accept high risk.
Patients with lower quality-of-life scores and those who perceived needing to lose more than 10% and 20% of weight to achieve âanyâ health benefits were more likely to have unrealistic weight loss expectations.
Low quality-of-life scores were also associated with willingness to accept high risk.
Conclusions and Relevance
Most patients seeking WLS have high weight loss expectations and believe they need to lose substantial weight to derive any health benefits.
Educational efforts may be necessary to align expectations with clinical reality.
GET. YOUR. COLONOSCOPIES. IT COULD SAVE YOUR LIFE. Don't be scared. It's no big thing. Really. The preparation is harder than the procedure. (My spouse is at this very moment, searching for a GI to make that appointment he canceled more than five years ago. He's a high-risk patient with family history.)
With that, I tell you - BOTTOMS UP!
(Reuters Health) - Obesity is already linked to a higher risk of colon or rectal cancer, but a new study suggests this risk is even greater for obese people who have undergone weight-loss surgery.
Based on a study of more than 77,000 obese patients, Swedish and English researchers found the risk for colorectal cancer among those who have had obesity surgery is double that of the general population.
Though colorectal cancer risk among obese patients who didn't have the surgery was just 26 percent higher than in the general population, researchers said the results should not discourage people from going under the knife.
"These findings should not be used to guide decisions made by patients or doctors at all until the results are confirmed by other studies," said Dr. Jesper Lagergren, the new study's senior author and a professor at both the Karolinska Institute in Stockholm and King's College London.
Each year more than 100,000 people in the U.S. have surgery to treat obesity.
Lagergren and his colleagues point out in their report, published in the Annals of Surgery, that obesity is tied to elevated risks for a number of cancers, including colorectal, breast and prostate (see Reuters Health story of November 3, 2011 here: reut.rs/t9sYxO).
Whether surgery to lose weight can affect those risks is uncertain.
Two earlier studies, one from the U.S. and the other from Sweden, found that the chances of obesity-related cancers decline after women have weight-loss surgery.
But an earlier study from Lagergren's group found the risks for breast and prostate cancers were unaffected by obesity surgery, and colorectal cancer risk increased.
To investigate that finding further, Lagergren's team collected 29 years' worth of medical records on more than 77,000 people in Sweden who were diagnosed as obese between 1980 and 2009. About 15,000 of them underwent weight loss surgery.
In the surgery group, 70 people developed colorectal cancer - a rate that was 60 percent greater than what would be expected for the larger Swedish population.
When the researchers looked only at people who had surgery more than 10 years before the end of the study period, the number of cancer cases was 200 percent greater than the expected risk for the general population.
In contrast, 373 people in the no-surgery group developed colorectal cancer, which was 26 percent more than would be expected in the population and that number remained stable over time.
A two-fold increased risk for colorectal cancer is not a "negligible risk increase, but it should not be of any major concern for the individual patient since the absolute risk is still low," Lagergren told Reuters Health in an email.
In the U.S., for instance, 40 out of every 100,000 women and roughly 53 out of every 100,000 men develop colorectal cancer each year.
Doubling that risk would make the annual figures 80 out of every 100,000 women and 106 out of every 100,000 men.
Lagergren said that more studies are needed to confirm his results before they should be included in clinical decision-making about whether patients should undergo weight-loss surgery.
The study results cannot prove that the surgery is the cause of the elevated cancer risk.
And, Lagergren says it's also not clear why the surgery might be tied to an elevated risk of colorectal cancer.
One possibility is that dietary changes after surgery, and increasing protein in particular, could raise cancer risk, he speculated.
Because the gut plays a significant role in the immune system, he added, "Another potential factor is that the bacteria that naturally reside in the intestines may change after surgery and alter future cancer risk."
Lagergren noted that he also couldn't rule out the possibility that residual excess weight and weight gain after surgery might be involved.
SOURCE: bit.ly/10TcCGy Annals of Surgery, online March 6, 2013
Objective: The purpose was to determine whether obesity surgery is associated with a
long-term increased risk of colorectal cancer.
Background: Long-term cancer risk after obesity surgery is not well characterized.
Preliminary epidemiological observations and human tissue biomarker studies recently
suggested an increased risk of colorectal cancer after obesity surgery.
Methods: A nationwide retrospective register-based cohort study in Sweden was
conducted in 1980-2009. The long-term risk of colorectal cancer in patients who
underwent obesity surgery, and in an obese no surgery cohort, was compared with that of
the age-, sex- and calendar year-matched general background population between 1980
and 2009. Obese individuals were stratified into an obesity surgery cohort and an obese
no surgery cohort. The standardized incidence ratio (SIR), with 95% confidence interval
(CI), was calculated.
Results: Of 77,111 obese patients, 15,095 constituted the obesity surgery cohort and 62,016
constituted the obese no surgery cohort. In the obesity surgery cohort, we observed 70
patients with colorectal cancer, rendering an overall SIR of 1.60 (95% CI 1.25-2.02). The
SIR for colorectal cancer increased with length of time after surgery, with a SIR of 2.00
(95% CI 1.48-2.64) after 10 years or more. In contrast, the overall SIR in the obese no
surgery cohort (containing 373 colorectal cancers) was 1.26 (95% CI 1.14-1.40) and
remained stable with increasing follow-up time.
Conclusions: Obesity surgery seems to be associated with an increased risk of colorectal
cancer over time. These findings would prompt evaluation of colonoscopy surveillance for the increasingly large population who undergo obesity surgery.
Did your nutritionist give YOU guidance in regards to carbohydrate intake after your roux en y gastric bypass surgery?
Background: Exact carbohydrate levels needed for the bariatric patient population have not yet been defined. The aim of this study was to correlate carbohydrate intake to percent excess weight loss for the bariatric patient population based on a cross-sectional study. The author also aimed to review the related literature.
Materials and Methods: A cross-sectional study was conducted, along with a review of the literature, about patients who underwent Roux-en-Y gastric bypass at least 1 year previously. Patients had their percentage of excess weight loss calculated and energy intake was examined based on data collected with a four-day food recall. Patients were divided into two groups: 1) patients who consumed 130g/day or more of carbohydrates and 2) patients who consumed less than 130g/day of carbohydrates.
Limitations: The literature review was limited to papers published since 1993.
Results: Patients who consumed 130g/day or more of carbohydrates presented a lower percent excess weight loss than the other group (p= 0.038). In the review of the literature, the author found that six months after surgery patients can ingest about 850kcal/day of carbohydrates, 30 percent being ingested as lipids. A protein diet with at least 60g/day is needed. On this basis, patients should consume about 90g/day of carbohydrates. After the first postoperative year, energy intake is about 1,300kcal/day and protein consumption should be increased. We can, therefore, establish nearly 130g/day of carbohydrates (40% of their energy intake)
Conclusions: Based on these studies, the author recommends that 90g/day is adequate for patients who are six months post Roux-en-Y gastric bypass and less than 130g/day is adequate for patients who are one year or more post surgery.
The author concludes that maintaining carbohydrate consumption to moderate quantities and adequate protein intake seems to be fundamental to ensure the benefits from bariatric surgery.
The research also suggests that a popular weight-loss operation, gastric bypass, which shrinks the stomach and rearranges the intestines, seems to work in part by shifting the balance of bacteria in the digestive tract. People who have the surgery generally lose 65 percent to 75 percent of their excess weight, but scientists have not fully understood why.
Now, the researchers are saying that bacterial changes may account for 20 percent of the weight loss.
The findings mean that eventually, treatments that adjust the microbe levels, or âmicrobiota,â in the gut may be developed to help people lose weight without surgery, said Dr. Lee M. Kaplan, director of the obesity, metabolism and nutrition institute at the Massachusetts General Hospital, and an author of a study published Wednesday in Science Translational Medicine.
Not everyone who hopes to lose weight wants or needs surgery to do it, he said. About 80 million people in the United States are obese, but only 200,000 a year have bariatric operations.
âThere is a need for other therapies,â Dr. Kaplan said. âIn no way is manipulating the microbiota going to mimic all the myriad effects of gastric bypass. But if this could produce 20 percent of the effects of surgery, it will still be valuable.â
In people, microbial cells outnumber human ones, and the new studies reflect a growing awareness of the crucial role played by the trillions of bacteria and other microorganisms that live in their own ecosystem in the gut. Perturbations there can have profound and sometimes devastating effects.
One example is infection with a bacterium called C. difficile, which sometimes takes hold in people receiving antibiotics for other illnesses. The drugs can wipe out other organisms that would normally keep C. difficile in check. Severe cases can be life-threatening, and the medical profession is gradually coming to accept the somewhat startling idea that sometimes the best therapy is a fecal transplant â from a healthy person to the one who is sick, to replenish the population of âgood germs.â
Dr. Kaplan said his groupâs experiments were the first to try to find out if microbial changes could account for some of the weight loss after gastric bypass. Earlier studies had shown that the microbiota of an obese person changed significantly after the surgery, becoming more like that of someone who was thin. But was the change from the surgery itself, or from the weight loss that followed the operation? And did the microbial change have any effects of its own?
Because it would be difficult and time-consuming to study these questions in people, the researchers used mice, which they had fattened up with a rich diet. One group had gastric bypass operations, and two other groups had âshamâ operations in which the animalsâ intestines were severed and sewn back together. The point was to find out whether just being cut open, without having the bypass, would have an effect on weight or gut bacteria. One sham group was kept on the rich food, while the other was put on a weight-loss diet.
In the bypass mice, the microbial populations quickly changed, and the mice lost weight. In the sham group, the microbiota did not change much â even in those on the weight-loss diet.
Next, the researchers transferred intestinal contents from each of the groups into other mice, which lacked their own intestinal bacteria. The animals that received material from the bypass mice rapidly lost weight; stool from mice that had the sham operations had no effect.
Exactly how the altered intestinal bacteria might cause weight loss is not yet known, the researchers said. But somehow the microbes seem to rev up metabolism so that the animals burn off more energy.
A next step, Dr. Kaplan said, may be to take stool from people who have had gastric bypass and implant it into mice to see if causes them to lose weight. Then the same thing could be tried from person to person.
âIn addition, weâve identified four subsets of bacteria that seem to be most specifically enhanced by the bypass,â Dr. Kaplan said. âAnother approach would be to see if any or all of those individual bacteria could mediate the effects, rather than having to transfer stool.â
A second study by a different group found that overweight people may be more likely to harbor a certain type of intestinal microbe. The microbes may contribute to weight gain by helping other organisms to digest certain nutrients, making more calories available. That study was published Tuesday in the Journal of Clinical Endocrinology & Metabolism.
The study involved 792 people who had their breath analyzed to help diagnose digestive orders. They agreed to let researchers measure the levels of hydrogen and methane; elevated levels indicate the presence of a microbe called Methanobrevibacter smithii. The people with the highest readings on the breath test were more likely to be heavier and have more body fat, and the researchers suspect that the microbes may be at least partly responsible for their obesity.
This type of organism may have been useful thousands of years ago, when people ate moreroughage and needed all the help they could get to squeeze every last calorie out of their food. But modern diets are much richer, said an author of the study, Dr. Ruchi Mathur, director of the diabetes outpatient clinic at Cedars-Sinai Medical Center in Los Angeles.
âOur external environment is changing faster than our internal one,â Dr. Mathur said. Studies are under way, she said, to find out whether getting rid of this particular microbe will help people lose weight.
Ghrelin is a hormone that is secreted primarily by stomach cells with lesser amounts secreted by other cells (as of the hypothalamus), that is a growth hormone secretagogue, and that has been implicated in the stimulation of fat storage and food intake. If you block it with bariatric surgery or another weight loss procedure (below...) weight loss occurs. At least it does for a while!
The first five patients to try a new, minimally invasive weight-loss procedure dropped an average of more than 45 pounds in six months, researchers report.
The procedure â called gastric artery chemical embolization (GACE) â works by blocking an artery in the stomach. This cuts off part of the blood supply to an area of the stomach that produces most of the hormone ghrelin, which stimulates appetite.
Now, we hear once AGAIN that roux en y gastric bypass bariatric surgery fixes diabetes damn near immediately. This is just another study on THAT topic.
We already knew this.
Thanks, pancreas! *thumbs up for working so well!*
*Waves to all the post bariatric reactive non-diabetic hypoglycemics*
2-year study indicates how gastric bypass reverses diabetes. In a substudy of the STAMPEDE trial (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently), Cleveland Clinic researchers have found that gastric bypass surgery reverses diabetes by uniquely restoring pancreatic function in moderately obese patients with uncontrolled type 2 diabetes.
Weight loss surgery does not lower health costs over the long run for people who are obese, according to a new study. Shocking? Meh. No.
Pre-op patients don't want to know this sticky business, so maybe you should close your eyes or click away. NOW. I don't want to pop your bubbles. I am not in the biz of selling weight loss surgery up in heah.
I don't think it would come as a surprise to many long-term post bariatric patients. I know you understand. We live it.
But that is just me, consider my stance as a nine year gastric bypass post op, married to a nine year gastric bypass post op, with a mother in law and sister in law who are both gastric bypass post ops. Collectively we have about 30 years of missed "obesity" costs, but we have increased our health-care costs in other areas. (*Looks at my current tally at the hospital.*)
The four of US (yes, this is totally biased because it is my immediate circle and what I know...this is understood, I am not arguing, I do not care to sell WLS nor unsell it!) are currently all maintaining a normal or slightly overweight body weight 6-9 years post bariatric surgery, however between us, we have created some seriously HUGE bills and other health conditions since having weight loss surgery. (I have not shared much of it because I'm already TMI and HIPPA cries.)
Imagine now if any of us have a full and complete regain - which is a totally and absolutely typical pattern. What then of our health? What if we have the comorbids of obesity come back? (Some of which don't always go away.... have you met my legs?) Just saying. I know we have made it this far, but it has NOT been cheap.
Some researchers had suggested that the initial costs of surgery may pay off down the road, when people who've dropped the extra weight need fewer medications and less care in general.
The new report joins other recent studies challenging that theory (see Reuters Health story of Jul 16, 2012 here: reut.rs/NrQKPU).
But, he added, "We need to view this as the serious, expensive surgery that it is, that for some people can almost save their lives, but for others is a more complex decision."
According to the American Society for Metabolic and Bariatric Surgery, about 200,000 people have weight loss surgery every year.
Surgery is typically recommended for people with a body mass index (BMI) - a measure of weight in relation to height - of at least 40, or at least 35 if they also have co-occurring health problems such as diabetes or severe sleep apnea.
A five-foot, eight-inch person weighing 263 pounds has a BMI of 40, for example.
For their study, Weiner and his colleagues tracked health insurance claims for almost 30,000 people who underwent weight loss surgery between 2002 and 2008. They compared those with claims from an equal number of obese people who had a similar set of health problems but didn't get surgery.
As expected, the surgery group had a higher up-front cost of care, with the average procedure running about $29,500.
In each of the six years after that, health care costs were either the same among people who had or hadn't had surgery or slightly higher in the bariatric surgery group, according to findings published Wednesday in JAMA Surgery.
Average annual claims ranged between $8,700 and $9,900 per patient.
Weiner's team did see a drop in medication costs for surgery patients in the years following their procedures. But those people also received more inpatient care during that span - cancelling out any financial benefits tied to weight loss surgery.
One limitation of the study was that only a small proportion of the patients - less than seven percent - were tracked for a full six years. Others had their procedures more recently.
The study was partially funded by surgical product manufacturers and pharmaceutical companies, including Johnson & Johnson and Pfizer. Claims data came from BlueCross BlueShield.
It's clear that surgery can help people lose weight and sometimes even cures diabetes, Weiner told Reuters Health. But it might not be worthwhile, or cost-effective, for everyone who is obese.
That means policymakers and companies will have to decide who should get insurance coverage for the procedure and who shouldn't.
"It's showing that bariatric surgery is not reducing overall health care costs, in at least a three- to six-year time frame," said Matthew Maciejewski, who has studied that topic at the Center for Health Services Research in Primary Care at the Durham VA Medical Center in North Carolina, but wasn't involved in the new study.
"What is unknown is whether there's some subgroup of patients who seem to have cost reductions," he told Reuters Health.
In the meantime, whether or not to have weight loss surgery is still a personal decision for people who are very obese, Weiner said.
"Every patient needs to talk it through with their doctor," he said. "It obviously shouldn't be taken lightly, but shouldn't be avoided either."
SOURCE: bit.ly/K8qAyI JAMA Surgery, online February 20, 2013.
Importance Bariatric surgery is a well-documented treatment for obesity, but there are uncertainties about the degree to which such surgery is associated with health care cost reductions that are sustained over time.
Objective To provide a comprehensive, multiyear analysis of health care costs by type of procedure within a large cohort of privately insured persons who underwent bariatric surgery compared with a matched nonsurgical cohort.
Design Longitudinal analysis of 2002-2008 claims data comparing a bariatric surgery cohort with a matched nonsurgical cohort.
Setting Seven BlueCross BlueShield health insurance plans with a total enrollment of more than 18 million persons.
Participants A total of 29 820 plan members who underwent bariatric surgery between January 1, 2002, and December 31, 2008, and a 1:1 matched comparison group of persons not undergoing surgery but with diagnoses closely associated with obesity.
Main Outcome Measures Standardized costs (overall and by type of care) and adjusted ratios of the surgical group's costs relative to those of the comparison group.
Results Total costs were greater in the bariatric surgery group during the second and third years following surgery but were similar in the later years. However, the bariatric group's prescription and office visit costs were lower and their inpatient costs were higher. Those undergoing laparoscopic surgery had lower costs in the first few years after surgery, but these differences did not persist.
Conclusions and Relevance Bariatric surgery does not reduce overall health care costs in the long term. Also, there is no evidence that any one type of surgery is more likely to reduce long-term health care costs. To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.
The REDUCE Pivotal Trial is a pivotal clinical study designed to develop valid scientific evidence regarding the safety and effectiveness of the ReShape Duo® as an adjunct to diet and exercise in the treatment of obese subjects with one or more obesity-related comorbid conditions.
Bariatric surgery led to sustained improvements in left ventricular mass and diastolic function in morbidly obese teenagers, a researcher reported here.
But, she noted, "even though the measures are significantly better, they're still not normal," indicating that interventions might have to occur sooner.
"These data support a more aggressive preventive approach to adolescent weight issues," Ippisch said.
The prevalence of childhood obesity has risen from about 5% in the 1970s to about 17% today, according to Stephen Daniels, MD, PhD, MPH, of Children's Hospital in Denver, who moderated a press conference at which the results were presented.
The severity of obesity has increased as well, he said, making bariatric surgery a treatment consideration for some of these kids.
Consensus criteria generally reserve bariatric surgery for children with a body mass index over over 50 kg/m2 or for those with a BMI over 40 kg/m2 and serious comorbidities such as obstructive sleep apnea and type 2 diabetes.
Ippisch said leaner children might qualify for bariatric surgery depending on the burden of comorbidities.
O'Brien PE, et al. "Long-term outcomes after bariatric surgery. Fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature" Ann Surg 2013;257:87-94.
Obese patients maintained about 50% excess weight loss for as long as 15 years after laparoscopic adjustable gastric banding, (LAGB), Australian investigators reported.
Experience at a single center showed an average of 47% excess weight loss in 714 patients followed for more than 10 years after LAGB, including 47% among patients followed for 15 years and 62% in a small group followed for 16 years, according to Paul O'Brien, MD, and colleagues, of Monash University in Melbourne, Australia.
A systematic review of published studies revealed a mean excess weight loss of 54% at 10 years and beyond for patients treated with LAGB or Roux-en-Y gastric bypass (RYGB), they reported in the January issue of Annals of Surgery.
The results also showed a marked reduction in late-occurring adverse events after LAGB, the authors added.
"Gastric banding is a safe and effective treatment option for obesity in the long term," they said. "The systematic review shows that all current procedures achieve substantial long-term weight loss. It supports the existing data that LAGB is safer than RYGB and finds that the long-term weight loss outcomes and needs for revisional surgery for these two procedures are not different."
Despite a history dating back more than 50 years, bariatric surgery has a paucity of long-term data to demonstrate durable weight loss. Most published studies have follow-up of less than 3 years. Systematic reviews have added relatively little in terms of long-term follow-up data, according to the authors.
O'Brien and colleagues introduced LAGB at their center in 1994, and have followed all patients by means of a dedicated bariatric surgery database. As of December 2011, O'Brien and co-author Wendy Brown, MBBS, PhD, also of Monash University, had treated 3,227 patients with LAGB.
The authors performed a prospective longitudinal cohort study of the patients. For comparison, they performed a systematic review of published literature on bariatric surgery. The focus was on long-term follow-up, 15 years for the cohort and 10 years for the systematic review.
The cohort had mean age of 47 and a mean presurgical body mass index of 43.8 kg/m2. The authors identified 714 patients followed for at least 10 years, including 54 patients followed for 15 years and 14 followed for 16 years.
The 10-year excess weight loss was 47%.
The authors reported that 26% of patients required revisions for proximal enlargement,
21% for port and tubing problems, and 3.4% for erosion.
Band removal was performed in 5.6% of patients.
During the first 10 years of clinical experience, the revision rate for proximal enlargement was 40%, declining to 6.4% during the last 5 years of the study period. Patients with and without revisions had similar excess weight loss.
The systematic review consisted of 19 published articles, 24 data sets, and approximately 14,000 patients. The data included six sets involving patients with LAGB, nine sets for RYGB, five sets for gastroplasty, three for biliopancreatic diversion or duodenal switch (BPD/DS), and one involving fixed open gastric banding.
According to the authors, every study had deficiencies related to data reporting. None of the studies was a randomized controlled trial. One investigation was a prospective, nonrandomized, matched interventional study, and the rest were observational studies.
With respect to safety, one perioperative death occurred in 6,177 LAGB procedures, compared with 21 in 2,684 RYGB procedures (P<0.001).
Excess weight loss at 10 years averaged 54% with LAGB and RYGB, 53% with gastroplasty, and 73.3% with BPD/DS. The mean revision rate was 26% with LAGB and 22% with RYGB. Revision rates from individual data sets ranged as high as 60% with LAGB and 38% with RYGB.
"The longitudinal cohort study of the LAGB patients shows that they have achieved and maintained a loss of nearly half of their excess weight to 15 years," the authors wrote. "The validity of the 15-year figure of 47% of excess weight loss is reinforced by the pooling of all long-term data (â¥10 years) and finding the same weight loss of 47% excess weight loss for the much larger group."
We have heard for years that being pear-shaped was preferable to other body-shapes, that carrying excess body-fat in the hips, thighs, legs and rear was 'healthier' than the belly. That 'pears' were a preferable body-shape to have than 'apples.' This is not necessarily so.
If you're pear-shaped and smug, a new study's findings may take you down a peg: For those at slightly increased risk of developing diabetes, fat stored in the buttocks pumps out abnormal levels of two proteins associated with inflammation and insulin resistance. (And that's not good.)
The new research casts some doubt on an emerging conventional wisdom: that when it comes to cardiovascular and diabetes risk, those of us who carry some excess fat in our hips, thighs and bottoms ("pear-shaped" people) are in far better shape than those who carry most of their excess weight around the middle ("apples").
The new study was posted online this week in the Journal of Clinical Endocrinology and Metabolism, and it focuses on a number of proteins, with names such as chemerin, resistin, visfatin and omentin-1, that could one day be used to distinguish between obese people headed for medical trouble and those whose obesity is less immediately dangerous.
The subjects in the study were all people with "nascent" metabolic syndrome â meaning patients who already have at least three risk factors for developing diabetes (large waist circumference, high blood pressure, high triglcerides, low HDL, or "good" cholesterol, and high fasting blood sugar) but no cardiovascular disease or diabetes complications yet.
The researchers found these subjects' "gluteal adipose tissue" â fat in and around the buttocks â pumped out unusually high levels of chemerin, a protein that has been linked to high blood pressure, elevated levels of C-reactive protein, triglycerides and insulin resistance, and low levels of good cholesterol. The blood and subcutaneous fat drawn from gluteal tissue also contained unusually low levels of omentin-1, a protein that, when low, is linked to high triglycerides, high circulating glucose levels and low levels of good cholesterol.
"Fat in the abdomen has long been considered the most detrimental to health, and gluteal fat was thought to protect against diabetes, heart disease and metabolic syndrome," said Ishwarlal Jialal, a professor of pathology and laboratory medicine and of internal medicine at UC Davis and lead author of the study. "But our research helps to dispel the myth that gluteal fat is innocent," he added.
A new study says being slightly overweight may actually help you live longer. Researchers looked at data on nearly three million adults around the world. They compared the body mass index, a measurement of weight in relation to height, to the risk of death. The study found people with a little extra weight had a six percent lower risk of dying compared to people considered "normal" weight. However, it's not an excuse to pack on the pounds.
Obese people had more than triple the risk of dying, according to the study.
The research looked at only death, not chronic medical conditions.
